Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
Clin Endocrinol (Oxf). 2014 Mar;80(3):459-63. doi: 10.1111/cen.12301. Epub 2013 Aug 21.
Postoperative radioiodine remnant ablation (RRA) represents an adjunctive therapeutic modality in patients with differentiated thyroid cancer (DTC). The impact of late vs early RRA on the outcome of DTC is currently unclear. The aim of the study was to evaluate the outcome of patients with DTC according to RRA timing.
A total of 107 TNM stage 1 DTC patients were divided into two groups. In group A (n = 50), RRA was administered in less than 4·7 months median 3·0 (range 0·8-4·7), while in group B (n = 57) in more than 4·7 months median 6 (4·8-30·3) after thyroidectomy. Remission was achieved when stimulated serum Tg levels were undetectable, in the absence of local recurrence or cervical lymph node metastases on the neck ultrasound.
All patients underwent near-total thyroidectomy. The mean age at diagnosis was 49·3 years (range: 18-79 years). There were no statistically significant differences in the histological subtype, the TNM stage, the dose of radioiodine and the time of follow-up, between the two groups. After the RRA treatment, 44 group A patients (88%) were in remission and 6 (12%) in persistence; while in group B, 52 (91·2%) were in remission, 1 (1·8%) in persistence and 4 (7%) in recurrence. At their latest follow-up median 87·3 (23·3-251·6 months), all patients were in remission, either as a result of further iodine radioiodine therapy (in 11 patients) or watchful monitoring.
The timing of RRA seems to have no effect on the long-term outcome of the disease. Therefore, urgency for radioiodine ablation in patients with low-risk thyroid cancer is not recommended.
放射性碘残留消融术（RRA）是分化型甲状腺癌（DTC）患者的辅助治疗方法。目前尚不清楚晚期与早期 RRA 对 DTC 结局的影响。本研究旨在评估根据 RRA 时机对 DTC 患者结局的影响。
回顾性研究患者：共纳入 107 例 TNM 分期 1 期 DTC 患者，分为两组。A 组（n=50）患者 RRA 时间少于 4.7 个月，中位数为 3.0（范围 0.8-4.7），B 组（n=57）患者 RRA 时间超过 4.7 个月，中位数为 6（4.8-30.3）个月。当刺激血清 Tg 水平不可检测、颈部超声无局部复发或颈淋巴结转移时，即达到缓解。
所有患者均行近全甲状腺切除术。诊断时的平均年龄为 49.3 岁（范围：18-79 岁）。两组患者的组织学亚型、TNM 分期、放射性碘剂量和随访时间均无统计学差异。RRA 治疗后，A 组 44 例（88%）患者缓解，6 例（12%）患者持续存在；B 组 52 例（91.2%）患者缓解，1 例（1.8%）患者持续存在，4 例（7%）患者复发。在最近一次随访时（中位数 87.3 个月，范围 23.3-251.6），所有患者均处于缓解状态，要么是因为进一步的碘放射性碘治疗（11 例），要么是因为密切监测。
RRA 的时机似乎对疾病的长期结局没有影响。因此，不建议对低危甲状腺癌患者进行放射性碘消融的紧迫性。
